Public Notices

HHSC withdrew its intent to submit Amendment 944, Transmittal Number TX 10-051, to the Texas State Plan for Medical Assistance, which would have proposed to cover certain pharmacy supplies as part of the home health benefit provided by a licensed pharmacy provider.

HHSC intends to submit amendments to the Texas State Plan for Medical Assistance, which would require HHSC to rebase acute care hospital rates within available funds.

Finally, HB 216, 81st Legislature, Regular Session, 2009, created Health and Safety Code Chapter 254, Boarding Home Facilities, directs HHSC to develop and publish model standards for the operation of boarding home facilities relating to construction and remodeling of boarding homes, and other provisions.

See the Texas Register for more information.

Adopted Rules

HHSC adopted amendments to §355.7101, concerning Cost Determination Process, and §355.7103, concerning Rate-Setting Methodology for 24-Hour Residential Child-Care Reimbursements, which will update and standardize the Department of Family and Protective Services (DFPS) facility-type language references in HHSC rules to current DFPS usage.

HHSC adopted an amendment to §370.401, concerning Perinates, in Chapter 370, State Children’s Health Insurance Program, which provides the Children’s Health Insurance Program Perinatal coverage to newborn children whose household income is above 185 percent of the Federal Poverty Level.

HHSC adopted amendments to §379.502, concerning preparing, providing, and serving food to residents; and §379.716, concerning DFPS licensing for shelter centers, in Chapter 379, Family Violence Program. The changes update the name of food benefits formerly known as food stands to reflect the current term, and to implement SB 68, which amended the code to require DFPS licensure of a child-care facility in a temporary shelter, including a family violence shelter center, that provides care for children temporarily residing in the shelter.

See the Texas Register for more information.

On DADS behalf, HHSC adopted amendments to the code concerning the following sections:

• Intermediate Care Facilities For Persons With Mental Retardation Or Related Conditions

• Licensing Standards For Assisted Living Facilities

• Licensing Standards For Home And Community Support Services Agencies

Public Notices

HHSC proposes new Medicaid per diem reimbursement rates for the Truman W. Smith Children’s Care Center ($219.69 ) and DADS-operated/state-operated ICFs/MR (small $603.64; large Medicaid-only: $537.41; large dual-eligible Medicaid/Medicare: $516.23).

See the Texas Register for more information.

HHSC intends to submit Transmittal Number 10-050, Amendment Number 943, to the Texas State Plan for Medical Assistance, which would add concurrent hospice care and treatment services for individuals younger than 21.

HHSC intends to submit an amendment to SCHIP, which would add concurrent hospice care and treatment services for SCHIP members.

Finally, HHSC intends to submit an amendment to the Texas State Plan for Medical Assistance, which would modify the reimbursement methodology in the State Plan for Nursing Facilities to delete the statement that the payment rates for the pediatric care facility class of service will be equal to the payment rates in effect on August 31, 2009, plus 2.79 percent effective, September 1, 2010.

See the Texas Register for more information.

Proposed Rules

The Texas Board of Nursing proposes to amend §217.6 (relating to Failure to Renew License) and §217.9 (relating to Inactive Status), and the reasons for the changes include clarifying existing requirements that apply to the reactivation of an expired (delinquent) or inactive nursing license, and specifying the new requirements that will apply to the reactivation of an expired (delinquent) or inactive nursing license.

See the Texas Register for more information.

Public Hearing and Notice

HHSC will hold a public hearing on August 2, 2010, at 1:30 p.m., to receive comment on proposed Medicaid payments for Case Management for Children and Pregnant Women, to be held in the Lone Star Conference Room of HHSC, Braker Center, Building H, located at 11209 Metric Boulevard, Austin, Texas.

Send written comments to the attention of Rate Analysis, HHSC, Rate Analysis, Mail Code H-400, P.O. Box 85200, Austin, Texas 78708-5200; by fax to Rate Analysis at (512) 491-1998; or by e-mail to esther.brown@hhsc.state.tx.us. Send comments by overnight mail or hand delivered to HHSC Rate Analysis, Mail Code H-400, Braker Center, Building H, 11209 Metric Boulevard, Austin, Texas 78758-4021.

HHSC intends to submit to CMS a request to amend the Consolidated Waiver Program: Waiver 0373 and Waiver 0374, which would add Medicaid Buy-In as a route to financial eligibility for the Consolidated Waiver Program.

Send written comments to the attention of Rate Analysis, HHSC, Rate Analysis, Mail Code H-400, P.O. Box 85200, Austin, Texas 78708-5200; by fax to Rate Analysis at (512) 491-1998; or by e-mail to esther.brown@hhsc.state.tx.us. Send comments by overnight mail or hand delivered to HHSC Rate Analysis, Mail Code H-400, Braker Center, Building H, 11209 Metric Boulevard, Austin, Texas 78758-4021.

See the Texas Register for more information.

Proposed Rules

The Texas Medical Board proposes to amend several sections of the code:

• General Provisions
• Licensure
• Medical Records
• Telemedicine
• Fees And Penalties
• Certification Of Non-Profit Health Organizations
• Investigations
• Texas Physician Health Program And Rehabilitation Orders
• Procedural Rules
• Disciplinary Guidelines
• Standing Delegation Orders

Click on the links for details about each proposed change.

Withdrawn Rules

The Texas Medical Board withdraws the proposed amendment to §174.2 and new §§174.7, 174.9, and 174.11 which appeared in the April 30, 2010, issue of the Texas Register (35 TexReg 3390). See the Texas Register for details.

Adopted Rules

HHSC adopted an amendment to §19.1921, in Chapter 19, Nursing Facility Requirements for Licensure and Medicaid Certification, to require a nursing facility to annually search the nurse aide registry and the employee misconduct registry and to keep a copy of the results of the searches in the employee’s personnel file.

HHSC also adopted amendments to §98.19 and §98.61, in Chapter 98, Adult Day Care and Day Activity and Health Services Requirements, to require an adult day care facility to annually search the nurse aide registry and the employee misconduct registry and to keep a copy of the results of the searches in the employee’s personnel file.

See the Texas Register for details about each adopted rule change.

Adult Day Care Providers (ADC) Contracted to Provide Day Activity and Health Services (DAHS):

When a licensed ADC facility that contracts with DADS to provide DAHS intends to relocate, the ADC must meet certain requirements to continue its licensing status and contracting relationship with DADS. (Letter)

NFs:

CMS is releasing a 3.0 version of the MDS assessments, effective October 1, 2010. An excerpt:

MDS 2.0 to 3.0 Workshops

New LTC workshops will be conducted from August 2010 through December 2010. These workshops outline the process to submit forms and assessments accurately and efficiently, summarize changes associated with the new MDS 3.0 assessment, and educate providers on benefits of utilizing the LTC Online Portal to complete and submit the LTCMI section.

In addition to the live workshops, providers can participate in an online, instructor-led, webinar version of the LTC workshop without leaving the office. These interactive webinars will be held in the months of August and December 2010. Alternatively, starting in September 2010, providers will be able to replay a recorded version of the first webinar offered in the series.

The schedule for MDS 2.0 to 3.0 workshops will be posted on the TMHP website by mid-July. Providers should check the workshop schedule and register online at http://www.tmhp.com/LTC Programs/ by scrolling to “LTC Program Resources” and clicking on Register for a Workshop. Providers are encouraged to register early.

Adopted Rules

The Texas Board of Nursing adopted amendments to §211.6, relating to Committees of the Board, which, among other things, direct the Board to determine the feasibility of conducting a pilot program to evaluate the efficacy and effect of deferring a final disciplinary action against an individual for minor violations of the Nursing Practice Act and Board rules.

The Board adopts amendments to §213.30, relating to Declaratory Order of Eligibility for Licensure, which, among other things, authorizes an individual to request a “criminal history evaluation letter” from a licensing authority if enrolled or intends to enroll in an educational program that prepares him for initial licensure, or is planning to take an examination for initial licensure, and has reason to believe he’s ineligible for licensure, because of a conviction or a deferred adjudication for a felony or misdemeanor.

Finally, the Board adopted amendments to §217.2, relating to Licensure by Examination for Graduates of Nursing Education Programs Within the United States, its Territories, or Possessions, §217.4, relating to Requirements for Initial Licensure by Examination for Nurses Who Graduate from Nursing Education Programs Outside of United States’ Jurisdiction, and §217.5, relating to Temporary License and Endorsement. An excerpt:

“The Board originally adopted §§217.2(b), 217.4(d), and 217.5(e) to ensure a fair and balanced process for all individuals requiring eligibility determinations from the Board. Since their enactment, these rules have ensured that all eligibility issues are reviewed by the Board through a single, unified process and that all similarly situated individuals are treated equally by the Board. The adopted amendments to §§217.2(b), 217.4(d), and 217.5(e) do not add new requirements to these sections or substantively alter the existing provisions of these sections. Further, the adopted amendments do not alter the Board’s historic interpretation or application of the provisions of these rules. Rather, the Board is adopting amendments to these sections in order to ensure continuing consistency and clarity in the interpretation and application of these rules.”

See the Texas Register for details about each rule change.

Public Notices

HHSC has proposed and adopted Medicaid payment rates for contracts not participating in the Attendant Compensation Rate Enhancement (the Enhancement) and the attendant compensation base rate for contracts participating in the Enhancement for non-state operated ICF/MR residential services and day habilitation services.

HHSC also proposed new per diem reimbursement rates for the non-state operated ICF/MR program and Nursing Facility program operated by DADS for Base Rates by RUG (Resource Utilization Group) class. In addition, facilities that verify liability insurance coverage acceptable to HHSC will receive different payment rates per day in addition to the above payment rates based upon the type of liability insurance coverage they maintain.

See the Texas Register for more information about each notice.

HHSC intends to submit amendments to the Texas State Plan for Medical Assistance, under Title XIX of the Social Security Act, to modify reimbursement methodologies based on fee changes to Birthing Center Services.

HHSC proposed to reduce reimbursement rates for the fixed and variable components of the pharmacy dispensing fee are proposed to by one percent. HHSC will also modify reimbursement methodologies for Physicians and Certain Other Practitioners, Ambulance Services, Family Planning Services, Home Health Services, Early and Periodic Screening, Diagnosis and Treatment, Case Management for Pregnant Women, Mental Health Rehabilitation Services, and Mental Health Targeted Case Management.

HHSC will submit a new 1915(b) Medicaid waiver application to the Centers for Medicare and Medicaid Services, to  replace the Disease Management 1915(b) waiver

For details about these three public notices, see the relevant section of the Texas Register.

Adopted Rules

HHSC adopted an amended §354.1231, Benefits and Limitations, which adds language related to hearing aid services for Medicaid clients younger than 21 years of age to the HHSC rule base and removes extraneous language. HHSC also adopted a new Division 35, §355.8660, concerning Renal Dialysis Reimbursement, which explains that the methodology is based on the composite rate reimbursement methodology used by Medicare, with the most recent update to the base rate derived from the Balanced Budget Refinement Act of 1999.

See the Texas Register for more information.

The Texas Medical Board adopts new §164.6, concerning Required Disclosures on Websites, which provides authority for the Board to adopt rules and bylaws as necessary to govern its own proceeding, perform its duties, regulate the practice of medicine in this state, enforce this subtitle; and establish rules related to licensure.

See the Texas Register for more information.

The Texas Board of Nursing adopted amendments to §221.1 (relating to Definitions) and §221.3 (relating to Education) to “(i) clarify that an applicant for advanced practice licensure must complete a qualifying program of study at the master’s degree level or higher; (ii) replace references to the term ‘specialty’ with references to the term ‘population focus area’; (iii) replace references to the term ‘advanced practice nurse’ with references to the term “advanced practice registered nurse’; and (iv) replace references to the term “authorization” with references to the term ‘licensure.’”

See the Texas Register for more information.

Public Hearing and Notices

HHSC will hold a public hearing on June 15, 2010, at 1 p.m., to receive public comment on proposed payment rates for the state-owned veterans nursing facilities, to be held  in the Permian Basin Room of the HHSC, Braker Center, Building H, located at 11209 Metric Boulevard, Austin, Texas.

HHSC intends to submit Transmittal Number 10-022, Amendment Number 915, to the Texas State Plan for Medical Assistance, under Title XIX of the Social Security Act, which would establish limitations on estate recovery mandated by section 115 of the Medicare Improvements for Patients and Providers Act of 2008, Publ. Law 110-275.

HHSC intends to submit to CMS a request to renew the STAR+PLUS program. See the Texas Register for more information about the hearing and notices.

Proposed Rules

HHSC proposes to amend Title 1, Part 15, Chapter 354, Subchapter A, Division 5, by adding new §354.1063, Preventable Adverse Events. Among the changes: reimbursement for physician services associated with preventable adverse events that occur in the hospital setting will be denied or reduced.

HHSC also proposes to add a new §354.1071, Additional Claim Information Requirements, and §354.7072, Authorized Inpatient Hospital Services, in Title 1, Part 15, Chapter 354, Subchapter A, Division 6, relating to present-on-admission requirements, preventable adverse events, and potentially preventable readmissions. Among the changes: a new §354.1070 that defines “present on admission,” “preventable adverse event,” and “potentially preventable readmission.”

See the relevant section of the Texas Register for details about the proposed changes and where to send written comments

The Texas Medical Board proposes to amend §§185.4, 185.7, 185.16, 185.22, and new §185.27, concerning Physician Assistants. Changes include deleting inaccurate language and providing clarifying language that the rule applies to determinations on active practice; and providing that a PA Board may revoke a temporary license when necessary. See the Texas Register for details.

HHSC proposes on DADS’ behalf to amend §90.3, concerning definitions, §90.11, concerning criteria for licensing, and §90.17, concerning criteria for denying a license or renewal of a license, in Chapter 90, ICFs/MR or Related Conditions. Changes include deleting definitions of the terms “affiliate,” “person with a disclosable interest,” and “manager” and adds a definition for “controlling person” to be consistent with the changes made by SB 806. A definition of “license holder” is also added for clarification.

See the Texas Register for more information.

Withdrawn Rules

HHSC adopted the repeal and replacement of §355.746, concerning Reimbursement Methodology for Mental Retardation Service Coordination, without changes to the proposed text as published in the April 2, 2010, issue of the Texas Register (35 TexReg 2695) and will not be republished. See the Texas Register for more information.

Adopted Rules

DADS adopted changes to five sections of the code:

• Mental Retardation Authority Responsibilities
• Mental Retardation Services–Medicaid State Operating Agency Responsibilities
• Nursing Facility Requirements For Licensure And Medicaid Certification
• Intermediate Care Facilities For Persons With Mental Retardation Or Related Conditions
• Licensing Standards For Assisted Living Facilities

Public Notices

HHSC will award contract 529-06-0425-00042 to Health Management Associates in Lansing, Michigan, to develop two deliverables, the State Medicaid Health Information Technology Plan and the Implementation Advance Planning Document. The contract’s total value is $641,010.

HHSC intends to submit an amendment to the Texas State Plan for Medical Assistance, which would add the non-state operated ICF/MR to the Attendant Compensation Rate Enhancement effective September 1, 2010. For more information about both notices, see the relevant section of the Texas Register.

Proposed Rules

HHSC proposes to amend §354.1311 and §354.1312 related to Medicaid substance abuse and dependency treatment services. An excerpt of the changes:

Amended §354.1311(a) deletes the reference to persons under age 21 since Medicaid is adding substance abuse benefits for adults. The amendment also updates the reference to the Department of State Health Services as the agency that licenses providers and facilities that provide substance abuse and dependency treatment services.

Amended §354.1311(b) clarifies the definition of chemical dependency to include substance abuse and dependency as defined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. This clarified definition is reflected in the proposed revised title of Division 22 and throughout the rules.

Amended §354.1311(c) expands existing program benefits by adding assessment, outpatient detoxification, and medication assisted therapy as benefits of the Medicaid program.

See the Texas Register for more information.

The Texas Board of Nursing proposes changes to several sections of the code:

• An amendment to §211.6,  which would include authorizing the deferral of final disciplinary actions against individuals as an alternative method of resolving certain violations of the Nursing Practice Act and Board rules. For details, see the Texas Register.

• Amendments to §213.30, relating to Declaratory Order of Eligibility for Licensure, which would include authorizing an individual to request a “criminal history evaluation letter” from a licensing authority if the individual is enrolled, or plans to enroll, in an educational program that prepares the individual for initial licensure, or is planning to take an examination for initial licensure, and has reason to believe he or she is ineligible for licensure due to a conviction or a deferred adjudication for a felony or misdemeanor offense. For details, see the Texas Register.

• Amendments to §217.2, relating to Licensure by Examination for Graduates of Nursing Education Programs Within the United States, its Territories, or Possessions; §217.4, relating to Requirements for Initial Licensure by Examination for Nurses Who Graduate from Nursing Education Programs Outside of United States’ Jurisdiction; and §217.5, relating to Temporary License and Endorsement, necessary to clarify existing language within the sections and to enhance consistency among Board rules related to eligibility determinations. For details, see the Texas Register.

NFs:

As a result of changes to 40 TAC Chapter 19, an applicant may request an Expedited Life Safety Code inspection for any initial application pending on June 1, 2010, and any initial application submitted to the DADS Licensing and Credentialing section, Regulatory Services division, on or after June 1, 2010. (Letter)

NFs must notify HHSC of any change in a Medicaid resident’s monthly income or resources as required by Chapter H of the Medicaid Eligibility for the Elderly and People with Disabilities Handbook. (Letter)

ALs:

As a result of changes to 40 TAC Chapter 92, an applicant may request an Expedited Life Safety Code inspection for any initial application pending on June 1, 2010, and any initial application submitted to the DADS Licensing and Credentialing section, Regulatory Services division, on or after June 1, 2010. (Letter)

PHC:

DADS clarified attendant qualifications and hiring guidelines in the PHC program. If an attendant has been designated as “Do Not Hire,” he may not be hired by the DADS case manager on the Form 2101, Authorization for Community Care Services. If he becomes qualified, the DADS case manager must complete a new Form 2101 to indicate the change in status. (Letter)

All Community Services providers:

DADS reminded all Community Services providers to screen employees and subcontractors to determine if they are excluded from participating in federal health care programs. Attached to the three-page letter are directions for searching state and federal online databases. (Letter)

CDSAs:

DADS reminded CDSAs to screen employees and subcontractors to determine if they are excluded from participating in federal health care programs. (Letter)

HCS:

DADS clarified billable activities for the social work component in the HCS program. An excerpt:

The definition and appropriate use of this service is not changing at the time of transition of the case management function from HCS Program providers to the local MRAs on June 1, 2010. Many provider requirements in the HCS rules at 40 Texas Administrative Code, Chapter 9, Subchapter D are considered administrative responsibilities of the HCS provider and are not billable activities under the social work service component.

Public Hearings and Notice

HHSC will hold a public hearing on May 24, 2010, at 9 a.m. to receive public comments on rates for the attendant compensation rate component for contracts not participating in the Attendant Compensation Rate Enhancement for the HCS, TxHmL, and ICF/MR programs.

The hearing will take place in the Lone Star Conference Room. For more information, contact Meisha Scott by telephone at (512) 491-1445; by fax at (512) 491-1998; or by e-mail at meisha.scott@hhsc.state.tx.us. See the relevant section of the Texas Register for more information.

HHSC will hold a public hearing on May 20, 2010, at 11 a.m., via videoconference, on Draft 2011 – 2015 Coordinated Strategic Plan at several locations, including the Brown-Heatly Building, Room 7230, 4900 N. Lamar Blvd., Austin; 9310 Tuscany Way, Suite 100, Austin; John H. Winters Building, Classroom 1, 701 W. 51st St., Austin; 6392 Iola Ave., Room 203, Lubbock; 4601 S. First St., Room K 106, Abilene; 801 W. Freeway, Lone Star Room, Grand Prairie; and 302 Rieck, Room 117, Tyler.

HHSC will hold a public hearing on June 21, 2010, from 10 a.m. to 12 p.m., for the Task Force on Strengthening Nonprofit Capacity. The hearing will take place at  El Paso Community College Administrative Services Center, Building A, Room A200, 9050 Viscount Boulevard in El Paso, Texas.

For details about both hearings, see the relevant section on the Texas Register.

HHSC proposes the following per diem reimbursement rates for Attendant Compensation Rate Enhancement Levels 1 through 25 for non-state operated ICF/MR. Read details here.

Proposed Rules

The Texas Board of Nursing proposes to amend §221.1 (relating to Definitions) and §221.3 (relating to Education), necessary to clarify existing language within the sections and to enhance consistency among Board rules related to advanced nursing practice. An excerpt:

“Specifically, the proposed amendments: (i) clarify that an applicant for advanced practice licensure must complete a qualifying program of study at the master’s degree level or higher; (ii) replace references to the term ‘specialty’ with references to the term ‘population focus area’; (iii) replace references to the term ‘advanced practice nurse’ with references to the term ‘advanced practice registered nurse’; and (iv) replace references to the term ‘authorization’ with references to the term ‘licensure.’”